Go Carts: Choosing Mobile Workstations Clinicians Dig

They’re here, they’re there, they’re everywhere. Mobile workstations, or computers on wheels (COWs), provide access to data all over the hospital, including the ED, ICU and OR, and can be used to move, store and place items, and chart patient information more accurately.

Integrated mobile computer carts can facilitate wireless clinical documentation at the point of care, enabling better care delivery and efficiency by allowing caregivers to get closer to the bedside while staying connected to critical data.

If you’ve ever shopped for them, you know the variety of carts is surprisingly wide, incorporating desktop, laptop, handheld, all-in-one, thin client, flat panel or tablet PCs; PACS workstations; patient monitors; bar coding solutions; medication bins and more. Many come in modular or configurable styles to support various applications.

“When choosing a cart system, size, maneuverability, ergonomics and battery life are all important,” says Laura Jantos, principal with ECG Management Consultants, a firm with experience in mobile system selection. “There is no one ‘perfect’ solution; it depends on what you’re trying to accomplish. The choice is very facility- and environment-specific, and also depends upon the nursing model the hospital is using.”

“Cart technology can reduce indirect ‘staff transport’ time [running around looking for information and materials], and maximize direct patient interaction time,” Jantos says.

Try before you buy

A test drive is a must in a variety of settings, Jantos says, whatever purpose you need to accomplish. She recommends demoing “carts from several vendors on multiple units with different functionality requirements.”

Roper St. Francis Healthcare, a Charleston, S.C., facility with 657 beds, held a “cart show” with loaners from various vendors, so that nurses and other staff could test them and complete questionnaires with their feedback. According to Lewis Flader, PC analyst, “We now have close to 180 carts in use; the oldest were introduced five years ago.”

Similarly, Christiana Care Health System, with more than 1,100 beds in two hospitals in Delaware, held its “cart fair” in a high-traffic area near the cafeteria, where staff could fill out surveys on their recommendations. “We have 350 carts in use in almost every area of both facilities,” says Carolyn Zsoldos, RN, BC, clinical support specialist.

The Brooklyn Hospital Center, a 367-bed community, not-for-profit hospital affiliated with the New York-Presbyterian Healthcare System, went live on an EMR system with mobile carts last March. The choice of carts began with multiple demos, says Irene Farrelly, vice president of information systems. “We visited other hospitals to see what they used, and tried a demo model before making the purchase,” she says. “We now have 50 carts deployed in all of our medical/surgical units.”

Phelps County Regional Medical Center, a 230-bed, critical access and acute-care public hospital in Rolla, Mo., held a “cart fair” as part of its clinical documentation initiative begun in 2004. Phelps is currently using 107 carts on all acute, skilled nursing and rehab floors, including the ICU.
 

Size and ergonomics matter

The space-saving footprint of mobile carts is a major selling point, but their compact size should be coupled with stability. “As long as it rolls easily, weight is not the factor it may seem,” Zsoldos notes. “However, it’s critical to make sure that carts roll smoothly on both carpeted and uncarpeted floors.” Adds Joe Abbott, assistant director of IT/technical support at Phelps, “We’d always like the carts to be lighter, but on the other hand, the battery and other components help with stability. We’ve never had a cart tip over on the hard-surface floors throughout our facility.”

“The weight of the cart can make or break it,” counters Flader. “Overcoming inertia from a dead stop when you’re pushing 125 to140 pounds over an 8-hour shift can be a problem.”

Weight and height have great impact on user comfort, safety and convenience, says Tamara James, ergonomics director at Duke University & Health System. “Clinicians are more comfortable when they have ergonomically sound equipment to work on,” she observes. “With mobile carts, you need to look at both the keyboard/mouse height [covering a range from seated to standing positions, ideally at elbow height] and the monitor height [with the top of the screen at eye level]. Ideally, these two should be independent/detachable [with the screen separated from the keyboard], for a full range of adjustability.”

“For maximum maneuverability and lower risk of back strain and fatigue, it’s better to push than pull, and the handle height should not require you to bend over to push the cart,” James notes. “However, the overall height should be low enough that your view is not blocked while pushing.”

At Phelps, user-friendly features included a full-size, tilting keyboard tray with wrist guard/rest, writing surface space, and large monitor. Nursing IT Coordinator Catherine Eikerman observes, “It was important that the nurses be able to see the screen clearly, taking into consideration their average age demographic [mid-40s].”

Brooklyn Hospital Center also selected carts with an adjustable keyboard, along with a sliding basket for paper charts and a locked cabinet for secure storage. “They can be moved up or down for standing or seated use,” says Farrelly.

The power play

For many institutions, one nagging issue with mobile carts has been power—a.k.a. battery life. More battery amps are not necessarily better for mobility—the bigger the battery, the heavier the cart, and the longer it takes to recharge.

“The equipment needs to work the way the nurses do, and be available when they need it,” James says. “When do they have downtime to recharge the cart or switch a battery? Everybody’s busy, so between shifts, the tendency is to say, ‘Let the next person take care of it.’ The larger question is, who is responsible for maintaining the carts?”

Phelps has addressed this question in several ways. “Our cart batteries initially could run 4 to 6 hours on a full charge. The nurses expressed frustration when carts ‘died’ on them,” says Abbott. “We knew we could provide support via our IT help desk, but nurses may be too busy to make that call in the fast-paced critical care environment. So, we decided to ‘take it up a notch’ and proactively inquire after them.” At Phelps, one IT person is exclusively dedicated to the carts, and goes out to the floors regularly to check them.

However, plugging in and cleaning the cart are considered part of the nurse’s responsibility. Phelps uses battery monitoring software to track and send alerts, making sure the carts are plugged in enough to maintain a full charge.

Meanwhile, Brooklyn Hospital Center created “grazing areas” for its COWs to be plugged into convenient hip-height outlets when they’re “parked” temporarily, and “pasture areas” for charging the batteries when not in use. “We find that the charge is still good after a 12-hour shift, even if the cart is not constantly plugged in,” says Farrelly.

At Roper St. Francis, on PC-style carts equipped with single or dual batteries, the power lasts 2 to 3½ hours on a single charge. “The battery voltage must be converted to A/C voltage for computer use, and 25 to 40 percent of power is lost [as heat] during the conversion, which is very inefficient,” Flader says. “We’re now looking at an all-in-one computer powered by 12-volt batteries, with no conversion required. That should give us 7 to 12 hours from a single battery charge.”

Mobile carts on the move

Cart technology continues to evolve, but the current models are not going away anytime soon. “We have now had over six years of positive experience with the carts, and we have been able to retrofit rather than replace them,” Abbott concludes. “Maximizing the carts’ lifespans has helped to protect our initial capital investment.”